Provider Demographics
NPI:1316243660
Name:GERALD ALAN HARPER, DDS, PC
Entity type:Organization
Organization Name:GERALD ALAN HARPER, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-726-4690
Mailing Address - Street 1:2650 SUZANNE WAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-7319
Mailing Address - Country:US
Mailing Address - Phone:541-726-4690
Mailing Address - Fax:541-741-7230
Practice Address - Street 1:2650 SUZANNE WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-7319
Practice Address - Country:US
Practice Address - Phone:541-726-4690
Practice Address - Fax:541-741-7230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5382261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR018622Medicaid
OR018622Medicaid